Everything
you need to know about visiting the Ob-Gyn

Bimanual Vaginal Abdominal Examination

If the doctor has an assistant they should help with lubricant.
This should be applied to the middle and forefinger of the doctor’s
hand. The lubricant package should not touch the glove. The doctor
should alert you verbally that the bimanual examination is about
to begin, again establishing a tactile signal. Take a deep breath
and exhale.

The doctor introduces the tips of two fingers into the vagina.
Then he/she inserts both fingers into the vagina up to the middle knuckle,
then turns the hand palm up and continues inserting, hyper extending
the thumb and flexing the 4th and 5th fingers toward the palm. They
should keep their hand flexible to keep the outside fingers from
agitating the external genitalia during this part of the exam. They
should be standing for this part of the exam.

The doctor palpates the vaginal rugae (tissue), checking for depth
and noting anything unusual such as cysts, scarring or deformity.
Now they locate the cervix. Checking the size direction, consistency
and tenderness of the cervix. (The cervix normally is firm,
but a hard cervix could indicate cancer.) Now they get their fingers
underneath the cervix. Remember to take a deep breath and relax
your abdominal muscles. With the inside hand pushing up gently,
and their outside hand pushing down on the abdomen, the doctor palpates
the uterus. They will note the size, position, consistency (firm vs. soft),
direction (anteverted vs. retroverted) and tenderness.

Next they move the vaginal fingers over with the abdominal hand
to palpate for each ovary. The ovaries are often difficult to palpate.
It’s very subtle. They note the thickness of the parametrial
tissue and whether there are any pelvic masses. They now remove
fingers smoothly, and remove the outer glove, holding hand down
and turning glove inside out to prevent any splattering. They should
discard the glove in biohazard waste bin or bag. With the help of
the assistant, they re-glove and again apply lubricant to middle and
forefinger of dominant hand.